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NHS reforms 'could divert money from research'

27 January 1990

By SHARON KINGMAN

THE BRITISH government’s proposals for reorganising the NHS could seriously
damage medical research in Britain, according to the Imperial Cancer Research
Fund.

Sir Walter Bodmer, director of research at the ICRF, said last week
that he feared charities would face increasing pressure to divert money
given to them for research to the care of patients. James Malpas, director
of the ICRF Medical Oncology Unit at St Bartholomew’s Hospital in London,
said major hospitals could be forced to opt out of research.

The fund spends more than Pounds sterling 40 million a year on research
and is responsible for about a third of all research into cancer in Britain.
Concern about the degree to which donations were being diverted to patient
care led the charity to examine how money spent in its main clinical units
was split between clinical research, basic care of patients, and teaching.

The survey found that 35 per cent of the Pounds sterling 1.9 million
that the fund spends on its unit at Bart’s went on support services for
patients. At the ICRF Clinical Oncology Unit at Guy’s Hospital in London,
more than 40 per cent of the budget of Pounds sterling 1.3 million was devoted
to patient care.

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In Oxford, the fund wanted to establish a clinical oncology unit, together
with a chair in the same subject. Before it could do so, the charity had
to underwrite costs for patient services of Pounds sterling 400,000 a year.

The fund suggests a new system for ensuring that the NHS pays for costs
such as laundry and food when hospital patients are taking part in research.
This should happen at present, but in practice it seldom does, the fund
says.

To overcome the problem, the ICRF suggests that all clinical research
being funded from outside the NHS should attract a supplement, to be paid
for by the NHS. This amount would be a fixed percentage of the external
funding. In the case of the ICRF, it says, the supplement should be 50 per
cent, although this figure may vary with different clinical specialities.

The fund also fears that the proposed changes will adversely affect
the ‘supply’ of patients suitable for inclusion in research programmes.
At academic centres, the costs of even routine care are higher, the ICRF
points out.

General practitioners, who will be able to hold budgets for the first
time under the government’s new proposals, may be reluctant to ‘buy’ relatively
expensive care for their patients. Other doctors may be obliged to send
their patients to the hospital with which the local health authority has
a contract for treatment. ‘As a result, the referral patterns so necessary
for research will be lost,’ the fund says.

The government has already hinted that there may be a ceiling on the
amount of money it will pay out to cover the indirect costs of research
carried out in universities but otherwise funded by charities. In its response
to the third report of the House of Lords Select Committee on Science and
Technology, Priorities in Medical Research, the government said: ‘. . .
there cannot be an unlimited commitment to university departments taking
on research projects which are sponsored by charities or others at less
than their full costs’.

Fears that a growth in private or charitable funding for medical research
might result in a reduction in support from the government are unfounded,
the report said.

The government has rejected the committee’s proposal that it should
set up a National Health Research Authority to bring the NHS into the mainstream
of medical research. Instead, the government intends to appoint a Chief
of Research and Development, who will advise the Secretary of State for
Health on research.